Reconstructive surgery for carotid artery occlusive disease in the elderly--a high risk operation?

Patients over 80 yr of age may require carotid surgery for symptomatic or critical asymptomatic carotid artery occlusive disease.A total of 2262 operations were performed between 1990 and 1999; 76 (3.4%) were carotid reconstructions in 70 patients over 80 yr of age. Twenty patients (26%) presented with asymptomatic critical stenosis. Transient ischemic symptoms were the reason for presentation in 35 patients (46%). Progressive stroke was documented in two patients (3%) and a stroke with persisting neurological deficit was demonstrated in 19 cases (25%). Coronary artery disease was present in 47 patients (38%) and arterial hypertension in 55 (72%). Fifty-nine patients (84%) were classified as ASA group 3. Seventy-one thromboendarterectomies of the carotid bifurcation with vein-patch closure were performed. Five patients had other types of reconstruction. Simultaneous operations (aorto-coronary vein-bypass, aortic interposition graft etc.) were performed in nine patients. Postoperative complications occurred in three patients. One had a transient neurological deficit and another a lethal stroke; the third patient died from myocardial infarction. The in-hospital mortality was 2.9%, which was not significantly higher than the results of the other 2186 reconstructions (1.5%). Surgery for carotid artery occlusive disease can be safely performed in selected patients of more than 80 yr of age.